Investment choices? County borough health expenditure in inter-war England and Wales

Urban History

Volumn 32, Issue 3, 2005, Pages 434-458

  Levene, Alysa ^a   Powell, Martin ^b   Stewart, John ^a  

^a OXFORD BROOKES UNIVERSITY   (United Kingdom)

^b UNIVERSITY OF STIRLING   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

CHILD WELFARE; HEALTH CARE; HEALTH EXPENDITURE; HEALTH POLICY; MATERNAL CARE;

EURASIA; EUROPE; UNITED KINGDOM; WALES; WESTERN EUROPE;

EID: 33749118475     PISSN: 09639268     EISSN: 14698706     Source Type: Journal    
DOI: 10.1017/S0963926805003238     Document Type: Article

References (51)

1. A. Levene, M. Powell and J. Stewart, 'Patterns of municipal health expenditure in inter-war England and Wales', Bulletin of the History of Medicine, 78 (2004), 635-69.
2. J.M. Mackintosh, Trends of Opinion about Public Health (London, 1953), 131, 132.
3. M. Powell, 'An expanding service: Municipal acute medicine in the 1930s', Twentieth Century British History, 8, 3 (1997), 334-57.
4. S.V. Ward, The Geography of Inter war Britain: The State and Uneven Development (London and New York, 1988), 157.
5. J.H. Warren, The English Local Government System (London, 1946), 46.
6. Several authors have pointed to the influence of local circumstances on expenditure decisions. For examples, see Levene, Powell and Stewart, 'Patterns of municipal health expenditure';
7. L.J. Sharpe and K. Newton, Does Politics Matter? The Determinants of Public Policy (Oxford, 1984)
8. J.R. Hicks and U.K. Hicks, 'Standards of local expenditure. A problem of the inequality of incomes', in Occasional Papers, National Institute of Economic and Social Research (Cambridge, 1943). We will turn to this theme in future articles.
9. Ward, The Geography of Inter-war Britain, 183. Croydon for example, spent at a high level on roads and parks, but at a lesser level on housing. Wakefield in contrast, prioritized roads and housing.
10. These sub-sector services consist of tuberculosis, maternity and child welfare, venereal disease, mental deficiency, 'lunacy', general hospitals, infectious disease, vaccination, notification of disease and medical salaries not included under one of the previous headings.
11. It is noteworthy that this removal of the overlapping functions of the Poor Law and the Public Health Committees had been called for in the Minority Report of the Poor Law Commission of 1905-09. Given the focus on the Liberal Welfare reforms, however, such a removal was sidelined and was not effected until 1929.
12. Recent exceptions have been Levene, Powell and Stewart, 'Patterns of municipal health expenditure'; M. Powell, 'Did politics matter? Municipal public health expenditure in the 1930s', Urban History, 22 (1995), 360-79.
13. See also, and their references, S. Cherry, Medical Services and the Hospitals in Britain, 1860-1939 (Cambridge, 1996)
14. A. Hardy, Health and Medicine in Britain since 1860 (Basingstoke, 2001)
15. C. Webster, The Health Services since the War, vol. I: Problems of Health Care. The National Health Service before 1957 (London, 1988).
16. Sub-sectoral studies have been undertaken for the environmental health services in the late Victorian and Edwardian periods -for example, F. Bell and R. Millward, 'Public health expenditures and mortality in England and Wales, 1870-1914', Continuity and Change, 13, 2 (1998), 221-49 - but not for the rapidly developing personal health services of the inter-war period.
17. Examples of more specialized studies include L. Bryder, Below the Magic Mountain: A Short History of Tuberculosis in Twentieth-Century Britain (Oxford, 1988)
18. J. Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and its Regions, 1752-1946 (Manchester, 1985)
19. J. Stewart, '"For a healthy London": The Socialist Medical Association and the London County Council in the 1930s, Medical History, 41 (1997), 417-36
20. and J. Welshman, Municipal Medicine: Public Health in Twentieth-Century Britain (Bern, 2000).
21. Powell, 'Did politics matter?', 363.
22. Ibid., 363.
23. J. Rowett, 'The Labour party and local government: Theory and practice in the inter-war years' (unpublished University of Oxford D.Phil. thesis, 1979), notes that this sectarianism was characteristic of Lancashire, with a strong Catholic body within the Labour party, and an anti-Catholic one outside. These associations made appeal beyond these lines difficult (249).
24. J.P. Bradbury, 'The 1929 Local Government Act: The formulation and implementation of Poor Law (health care) and Exchequer grants reform for England and Wales (outside London)' (unpublished University of Bristol Ph.D. thesis, 1991), 302-5
25. D.N. Chester, Central and Local Government; Financial and Administrative Relations (London, 1951), 125-8, 288-9,
26. J.M. Drummond, The Finance of Local Government (London, 1952), 88, 99-110.
27. The local government financial statistics on which these data are based are not complete for individual services in the financial year 1921-22. The collection and publication of financial returns was also interrupted by World War II, so that the last inter-war return was published for 1936-37. For the sake of continuity, we thus consider the period 1922-36 when we refer to the inter-war years.
28. For example, the Welsh borough of Merthyr Tydfil spent under this head only in 1935, while several other boroughs had years in which they did not record expenditure.
29. Bradbury ('The 1929 Local Government Act', 296) states that the change in the grant system under the 1929 Act did not adversely affect expenditure on services which had previously been aided by the percentage grants. He does, however, provide evidence of county boroughs where the block grant 'confirmed reactionary attitudes' (302), or was used 'to arrest even existing development' (305). The poorer boroughs should have benefited most from the weighting formula, but may have suffered in the national drive for economy, which prompted many poor councils to use the grant to reduce pressure on the local rates.
30. Ward (The Geography of Inter-war Britain, 173-80) states that the block grants did not materially assist the poorer boroughs until a greater weighting system was introduced in 1937. Further, capital expenditure by poorer boroughs was discouraged, through a secret blacklisting system ('List Q'), which affected which boroughs received loan sanctions.
31. In 1932, 49 of the 83 county boroughs were on this list at varying levels of severity. S.V. Ward, 'Implementation versus planmaking: The example of List Q and the depressed areas 1922-39', Planning Perspectives, 1 (1986),3-26; National Archives HLG52/1344-5, Financial Position of Local Authorities.
32. The slight differences between the coefficient of variation and the standard deviations shown in Figure 2 arise from the fact that the former is related, and therefore affected by, the mean expenditure, while the latter is not.
33. M. Thomson, The Problem of Mental Deficiency. Eugenics, Democracy and Social Policy in Britain, c. 1870-1959 (Oxford, 1998), 55, 128.
34. D. King, In the Name of Liberalism. Illiberal Social Policy in the United States and Britain (Oxford, 1999), 67-72, also notes the perception that mental deficiency was growing in the early inter-war period, reinforced by the 1929 Wood Report into mental deficiency. He also highlights the uneven implementation of the 1913 Mental Deficiency Act.
35. The mental health services had their roots much further back in time than many of the services which were expanding in the inter-war period, and this may have impeded their development in the 1920s and 1930s. Philo notes the widespread network of mental asylums which were set up in Britain in the nineteenth century, in a deliberate attempt to minimize the amount of 'distance-decay' in their usage. C. Philo, 'Journey to asylum: A medical-geographical idea in historical context, Journal of Historical Geography, 21, 2 (1995), 148-68. This network, which placed asylums in local centres of populations may have meant that they fell under the responsibility of the administrative county rather than being in the centre of towns and therefore falling to the county boroughs. This may partly account for the uneven pattern of development of mental hospitals in the inter-war period.
36. Elsewhere, we note that mental hospitals did attract a high level of capital investment in this period, despite the generally low expenditure from the revenue accounts: Levene, Powell and Stewart, 'Patterns of municipal health expenditure'.
37. Hicks and Hicks, 'Standards of local expenditure', 9.
38. Bradbury, 'The 1929 Local Government Act, 304
39. E. Peretz, 'The costs of modern motherhood to low income families in inter-war Britain', in V.A. Fildes, L. Marks and H. Marland (eds.), Women and Children First: International Maternal and Infant Welfare, 1870-1945 (London, 1992), 257-80
40. E. Peretz, 'Infant welfare between the wars', in R.C. Whiting (ed.), Oxford. Studies in the History of a University Town since 1800 (Manchester, 1993), 131-45.
41. Displaying a mean z-score above 1. The z-score measures the distance of a point from the mean, and is calculated by means of (n-mean)/standard deviation.
42. Notification had been made compulsory under the terms of the 1913 Public Health (Prevention and Treatment of Disease) Act.
43. W.M. Frazer, A History of English Public Health, 1834-1939 (London, 1950), 414
44. I. Loudon, Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800-1950 (Oxford, 1992), 207-8
45. N. Wilson, Municipal Health Services (London, 1946), 14
46. Bryder, Below the Magic Mountain, 41, 70-1
47. Thomson, The Problem of Mental Deficiency, 39.
48. MCW expenditure was matched by a 50% grant from 1915, and mental deficiency from 1916. VD attracted a 75% grant from 1916. In 1921, a 50% grant was attached to expenditure on TB. M. Newcomer, Central and Local Finance in Germany and England (New York, 1937), 346-7.
49. This dichotomy was first suggested by Hicks and Hicks ('Standards of local expenditure').
50. These surveys were made of all county boroughs and county councils, and were designed to examine how far the terms of the Local Govermnent Act of 1929 were being implemented. The survey reports are held at the National Archives, MH66 419-1023.
51. An intensive campaign in Rochdale in the 1930s to increase obstetric care resulted in a much lowered rate of maternal mortality. I. Loudon, 'Some international features of maternal mortality, 1880-1950', in Fildes, Marks and Marland (eds.), Women and Children First, 15.